Study Underscores Health Care Access Concerns for Elderly in India

By Admin

22 Apr, 2025

India's aging population is growing rapidly, but the nation’s health care system is struggling to keep pace, particularly in terms of accessibility. A recent study published in The Lancet Regional Health – Southeast Asia paints a concerning picture of how physical distance remains a critical barrier to timely and essential medical care for older adults in India.

Urban vs. Rural Divide

The research, titled “Miles to go before I seek: distance to the health facility and health care use among older adults in India”, highlights stark urban-rural disparities in health care access. Nearly two-thirds (67%) of older adults—defined as individuals above the age of 60—in urban India access outpatient care within a 10km radius. In contrast, those in rural and remote areas must travel an average of 28.3km for the same services.

When it comes to hospitalisation, the figures are even more alarming. On average, elderly individuals travel 43.62km for in-patient care and 14.54km for outpatient care. Distances are significantly longer in rural regions, with the time and effort involved often acting as deterrents to seeking timely medical attention.

Transport and Infrastructure Challenges

The disparity is most evident in in-patient care. Rural elderly individuals often travel twice the distance and time compared to their urban counterparts. According to the study, 95% of older adults arrange their own transport, and only 5% use ambulances—revealing no significant urban-rural difference in transport mode, but underlining the lack of accessible emergency services.

States such as Tripura (80.4%), Manipur (70.4%), and Kerala (59%) show higher rates of in-patient visits within 0-10km, attributed to better infrastructure or reliance on nearby facilities during emergencies. However, hilly states like Nagaland (0%), Sikkim (17.6%), and Himachal Pradesh (4.5%) report much lower proximity-based visits, reflecting difficult terrains and limited facilities.

Distance Discourages Usage

Utilisation of both outpatient and inpatient care is directly linked to distance. When facilities are within 10km, outpatient care usage is high at 73%, and inpatient care at 40%. However, as distances increase, these figures drop steeply—to 17% for facilities 11-30km away, and just 10% beyond 30km. Vulnerable groups such as women, individuals with low income or education, and those living alone, face the steepest decline in service usage.

Disturbingly, 19% of rural older adults and 10% of urban dwellers must travel over 60km to access hospitalisation. This burden significantly heightens the risk of health complications due to delayed care.

Demographic Pressures and Systemic Gaps

India currently has 138 million older adults, a number that is rising sharply. The elderly population is projected to increase from 7.4% in 2001 to 13.2% in 2031. Many among them suffer from chronic and debilitating health conditions that require continuous care. However, access remains hindered by not just distance, but also poor local health services, financial limitations, and low health literacy.

Regional Variation and Insights

States like Uttar Pradesh, Bihar, and Madhya Pradesh reflect moderate outpatient care access (11–60km), but report high numbers of inpatient visits over 30km. In contrast, the relatively lower variability in southern states indicates a better-distributed health infrastructure.

Recommendations: Bridging the Gap

The study emphasizes the need to address transportation barriers. Interventions like subsidised transport, mobile health units, and improved emergency services could enhance access and outcomes for elderly patients—especially in remote and underdeveloped regions.

The authors conclude, “Longer travel time and farther facility act as a potential barrier for receiving timely and essential health care… Various studies have shown that interventions aimed at minimising transportation barriers among low-income, remote, and older populations not only improve access to medical care but also patient outcomes, while being cost-efficient.”

As India continues its demographic transition, rethinking the geographic reach and equity of its health care delivery system will be essential to ensure no older adult is left behind due to miles that stand between them and the care they need.